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HomeMy WebLinkAboutCOM2005-00024 - COM Permit / Conditions - 2/11/2005 \J -C p, m OF Ol o —1 r N y o O y �D (A � . v (D v � mmz cnm o m m a =J oz > cl) ' .2 b 0 co a z o a -C 0 U) U) 7 7 of -i tk6 r G Q Z - •• N w G l � c o o D D /� y ai 3 N O O fA �Q . I 3 3 ? .� 61 � m w <OD � Nmf Z W 0 a CO) m o DrnOmn (p C O w m 'co O �jjc G) < .. O O m � ,- O -9m s �+ m w 3 Q � m m O 3 ao m � 0 OD v C4 v c r WCO) o � c 3 to �. Z o, C r M SDnWi _a c Z co �z 0 Dm CL 5aD m IEr = 1 0 r �i r P. a 9 m a g 0 _ n? -n m =i go 8 O o 9 C o 0 - m p � cn .. .. m Cis CD y fl ;mo a � ca0a N J J J N o O rg3 $ iU .� a, � 4 N N i n 0 ? CA) N m O 91 X � �'� X -no -I Xcoa ;uacLo XD -nWo -p N � o -• c � zv l� m00 o mcov_IC m <. a' 38 � pmW w� .. o � z0 '°. tpc:)0 g � ,mv =+ o ngCzZ 4y = 0 m DpO� D " ;a zpFn6))-1 . ... NZrCAm0 �7' 000 Z 02 Zomz zc �00 � W - you D4 Az m� 3 � �mm > > r Dv 0 0 0cmi) zCz c y o 02mav �j �D�-�,'� > omZO vm8�.m � ,v m6A '< z > > cn > 0 c� � 9 -40c- < S a w M ;a0 0 -1 �m �mOv 'a act zn 0c g �mzt� w = m m N ' = � �cnc 20 m �-� cn y-<b - zzv r OO mOr �Ov, 'gym v= -Irr m = rn �ovm � � �'aMe m �� � a� 5Cmpz ZgNs - M22co c Mrr° � m c� Omry 0m $-44 � 080m � _ a > :; z0m OcOcoo z—O '" c S. aB _m m ANcOmm m� D � z � _ c < vmA Oy0mNm9m c � mca ° cr � �O= m �U�rni�Z Omprn � � � � m �� -a Ooy� mz � � O c N � (D FOX?m �r � -nm cm00mv y w O° „ m c M ;u0 j $ � � p6mr Wm '- Oc o ° NO � � � cm 04. Z -- zvW o c N � Drn 00DD G)00-n � tD ,z rn007pz � z0 0 z� -� Ocn $CA ` W N -0W ;a OyZ0 cn Oz0 fir 0 o r —n a W -IZZ co)F mm =gym b 2zD r-0Ap rm -oC _ Q, W — . D 0pCm700 �Mmf Ag MOOO x � W yz m0 -1c61 mm � Ja2OZ0 ornMm y-v WOM3 05 0mz c z -490� moo. <_ s c W z ; cn v W vc < z D> m 09z' rnv $ 3 3 -IZCm Q0m *- m > Zc m IS X m O� c E O M-� zoo . orn. z � rn � � � Zm � Wc = $ to -� O cn CO) D -f < vi Z k $ , 91 t All o . W < % . 2 q§ ° � �� 2 Uz e - a a . o f�� § © q E § ce ■� . . § 18 E � ■� � � a . . . . 7 8 / . . g � E� t ƒgam g �2 m ® . . 2a § g � . 7R k EM � CA) a. § 0 A J § a $ \ � a � FORM MUST BE COMPLETED IN INK PLEASE PRESS MARD PERMIT NO.: CO m �00� MASON COUNTY 6C>C) DEMOLITION PERMIT APPLICATION - 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner M C E !0 ':� J Contractor Name -9.a_Q Mailing Address / Mailing Address City State_&.24 Zip Code Y City State Zip Code Phone(36 0)Z yS "P..3Other Ph. Ph.( Other Ph.0 Lien/Title Holder Contractor Reg. # Address Expiration PARCEL INFORMATION-12 digit Tax Parcel No. /.2 0 F /—_/ !?60JG Fire District_ Legal Description L o7` p D Site Address(include street name and city D L Directions to site: <A 4,e Is your property within 200' of the following: Body of Water(Name) Saltwater Laker &2 River/Creek/Va Pond_A&_Wetland & Seasonal Runoff Al 0 Stream_AW Slopes or Bluffslf your project is located adjacent to or within an area that is listed above, it is advisable to contact the Dept. of Community Development regarding future development prior to demolition;since removal of an existing structure could affect future building locations. How will the debris be disposed of? - ` What is the use of the building being demolished? /YQ A D Y'1 h NOTICE: THIS PERMIT BECOMES NULL R VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtainin rovaf. be made without first obtaining approval. X Date JO S X Date Provide a plot plan indicating location of improvements and structure to be demolished. JU RECEIVED FEB 11200� 426 W. CEDAR S FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department �/ Occ GrpType of Const. �^ Planning Department 23-/ O Fire Marshal FEES Building Permit Fee Other Violation Fee Other Site Inspection Pre-Paid at Submittal ( ) TOTALFEES